Endoscopic sleeve gastroplasty
In endoscopic sleeve gastroplasty (ESG), doctors use an endoscope with an attached device that places sutures in the stomach, drawing the front and back walls together to create accordion-like folds that change its shape into a tube or sleeve. When these folds are stitched into stomach tissue, the stomach has less room to hold food. With a smaller stomach, people feel full faster and tend to eat less. ESG doesn't require incisions and leaves no external scars. The sutures do not dissolve; the stomach tissue heals around them to form the new shape.
ESG takes about 90 minutes, with patients under general anesthesia (completely asleep). Most can go home the same day as the procedure. Post-treatment precautions generally include taking one or two days off from work and avoiding heavy lifting.
In the first days after the procedure, patients follow a full liquid diet before transitioning to soft foods (such as oatmeal, bananas and soft-cooked rice). A return to more normal eating patterns takes place gradually over a few weeks.
Patients who have ESG typically lose 15 to 20% of their body weight. This may be accompanied by improvements in weight-related health conditions, including sleep apnea, high blood pressure, type 2 diabetes, nonalcoholic fatty liver disease (now called metabolic dysfunction – associated fatty liver disease) and unhealthy cholesterol levels. In some cases, these conditions may fully resolve.
Patients need a body mass index (BMI) of at least 30 or a BMI of greater than 27 with associated conditions to qualify for ESG.
Endoscopic revision of gastric bypass
In people who have undergone gastric bypass surgery, weight regain can result when the outlet connecting the surgically created pouch and the small bowel stretches and expands over time. An endoscopic procedure can help restore the initial results of the surgery and put patients back on the path to weight loss.
We currently offer two minimally invasive procedures to treat weight regain after gastric bypass. For optimal results, we tailor these treatments to each patient's specific anatomy. Our team works closely with patients to understand their presurgical and postsurgical histories, identify the core factors contributing to their weight regain, and help them decide which procedure to pursue.
Revision procedures for gastric bypass include:
- Transoral outlet reduction. The gastric outlet (where the gastric pouch and small intestine meet) is tightened to restore the feeling of fullness after eating.
- Argon plasma coagulation. When this technique is applied to revising a gastric bypass, an endoscope is used to deliver ionized argon gas, which tightens the gastric outlet. Several sessions may be required.
Endoscopic revision of sleeve gastrectomy
Weight regain after sleeve gastrectomy can be due to stretching of the stomach over time. We offer the sleeve-in-sleeve endoscopic procedure to address this problem. Doctors use sutures to create plications (folds) in the stomach that decrease the volume of the sleeve, restoring its original postsurgical tightness.
Endoscopic revision of bariatric surgery complications
Our team is experienced in using minimally invasive procedures to manage complications of bariatric surgeries. We can address complex and rare problems, including staple line leaks, gastrogastric fistulas, ulcers, strictures, gastric outlet stenosis (narrowing), gastric band erosion and gastric sleeve stenosis.
